A diagnosis of Alzheimer’s disease can catch families off guard. When such a diagnosis is made, patients and their families typically have a host of questions, including how far the disease has progressed and what to expect as it advances.

One potential side effect of Alzheimer’s disease that can catch families off guard is sundowning. The National Institute on Aging notes that sundowning refers to the restlessness, agitation, irritability, or confusion that can begin or worsen as daylight begins to fade. Sundowning is difficult for Alzheimer’s sufferers, but also can be especially hard on their caregivers. As day turns to night, people serving as caregivers to Alzheimer’s patients tend to wear down, only to suddenly realize that the people they’re caring for are becoming increasingly difficult to handle. The NIA notes that sundowning can continue well into the night, compromising patients’ ability to fall asleep and stay in bed.

Sundowning will not affect every Alzheimer’s patient, but caregivers should prepare themselves to handle such a situation should it arise. Learning more about sundowning can be part of that preparation.

Why does sundowning occur?

The exact cause of sundowning, which is sometimes referred to as “late-day confusion,” is unknown. However, the Mayo Clinic notes that certain factors may aggravate the feelings of confusion felt by Alzheimer’s patients who experience sundowning. Those factors include:

• fatigue
• low lighting
• increased shadows
• disruption of the body’s internal clock
• the presence of an infection, such as a urinary tract infection

The NIA notes that one theory suggests Alzheimer’s-related changes in the brain can disrupt a person’s internal clock, confusing their sleep-wake cycles as a result. That can confuse Alzheimer’s patients and contribute to the feelings of agitation and irritability that are common among people who experience sundowning.
What can be done to combat sundowning?

The NIA recommends looking for signs of sundowning in late afternoon and early evening and trying to determine what might be causing these behaviors. Try to avoid anything that appears to trigger these behaviors, if possible.

Reducing noise, clutter or the number of people in the room when sundowning symptoms typically appear may help reduce the confusion Alzheimer’s patients feel during this time of the day. In addition, scheduling a favorite activity or providing a favorite snack at this time of day can give Alzheimer’s patients something to focus on, potentially cutting off the confusion before it surfaces.

The NIA also recommends making early evening a quiet time of day reserved for playing soothing music, reading or going for a walk. Caregivers who also have children to look after can explain the importance of this quiet time to youngsters and ask for their cooperation.

Closing curtains or blinds and turning on the lights at dusk can minimize shadows in the house, potentially making this time of day less confusing for Alzheimer’s sufferers.

Sundowning is a symptom of Alzheimer’s disease that can be difficult for caregivers to manage. More information about sundowning is available at http://www.nia.nih.gov.